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SPINAL CORD: EXTERNAL FEATURES & BLOOD SUPPLY

SPINAL CORD: EXTERNAL FEATURES & BLOOD SUPPLY. Dr. Ahmed Fathalla Ibrahim. NERVOUS SYSTEM. STRUCTURAL CLASSIFICATION: CENTRAL NERVOUS SYSTEM (CNS): Brain , spinal cord PERIPHERAL NERVOUS SYSTEM (PNS): Cranial nerves (carry impulses to & from the brain) + related ganglia

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SPINAL CORD: EXTERNAL FEATURES & BLOOD SUPPLY

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  1. SPINAL CORD: EXTERNAL FEATURES & BLOOD SUPPLY Dr. Ahmed Fathalla Ibrahim

  2. NERVOUS SYSTEM • STRUCTURAL CLASSIFICATION: • CENTRAL NERVOUS SYSTEM (CNS): Brain, spinal cord • PERIPHERAL NERVOUS SYSTEM (PNS): • Cranial nerves (carry impulses to & from the brain) + related ganglia • Spinal nerves (carry impulses to & from spinal cord) + related ganglia

  3. FUNCTIONAL CLASSIFICATION OF PNS • Sensory (afferent) division:consists of nerves that conduct impulses to CNS • Motor (efferent) division:consists of nerves that conduct impulses from CNS. It is divided into: • Somatic nervous system:concerned with voluntary control of skeletal muscles • Autonomic nervous system:concerned with involuntary control of glands, smooth & cardiac muscles

  4. STRUCTURE & FUNCTION OF NERVOUS TISSUE • THE NERVOUS TISSUE IS FORMED OF TWO TYPES OF CELLS: • NEURONES • NEUROGLIA

  5. NEURONES • Function: conduct nerve impulses • Structure: formed of • Body: contains nucleus • Processes: axon (a single process that conducts impulses away from the cell body) & dendrites (one or more processes that conduct impulses to the cell body)

  6. NEURONES • Coverings: • Myelin sheath:fatty sheath, present in both CNS & PNS, formed by: neurilemma (in PNS) & neuroglia (in CNS), function: insulates neurones • Neurilemma (Schwann cells):cellular sheath, present in PNS only, function: regenerates axons & forms myelin

  7. CLASSIFICATIONS OF NEURONES • According to number of processes: • Unipolar neurons • Bipolar neurons • Multipolar neurons • According to function: • Sensory (afferent) neurones: carry impulses from receptors to CNS • Motor (efferent) neurones : carry impulses from CNS to muscles & glands • Interneurones: connect sensory & motor neurones

  8. NEUROGLIA • Function: support, protect & insulate neurons • Difference between neuroglia & neurones: • Neuroglia do not transmit nerve impulses • Neuroglia never lose the ability to divide

  9. DEFINITIONS • NUCLEUS:Collections of cell bodies of neurones having the same function found in CNS • GANGLIA:Collections of cell bodies of neurones having the same function outside CNS • TRACT:collection ofaxons of neurones having the same origin, termination & function found in CNS • NERVES:collection ofaxons of neurones having the same origin, termination & function outside CNS • GREY MATTER OF A PART OF CNS:collections of all nuclei in that part of CNS • WHITE MATTER OF A PART OF CNS:collections of all tracts in that part of CNS

  10. PROTECTION OF CNS • BONE: Skull, vertebral column • MENINGES: 3 fibrous membranes that covers the CNS: • Dura matter: outer, tough • Arachnoid matter: middle, web-like • Pia matter: inner delicate, vascular • CEREBROSPINAL FLUID: • Fluid similar to plasma in composition • Formed from blood in the capillaries present inside cavities of CNS (Choroid plexus) • Circulates in cavities of CNS then around CNS (between arachnoid & pia matter) • Forms a water jacket around CNS

  11. THE SPINAL CORD

  12. THE SPINAL CORD • Shape: cylindrical • Position:occupies the upper 2/3 of vertebral canal • Origin:continuation of medulla oblongata through the margin of foramen magnum • Termination: • In adult life: it narrows to form the conus medullariswhich ends at the level of the disc between L1 & L2 • Until 3rd month of fetal life: it occupies the entire length of vertebral canal • At birth: it ends at the level of L3

  13. THE SPINAL CORD • Segments:divided into 31 segments ( 8 cervical, 12 thoracic, 5 lumbar, 5 sacral & 1 coccygeal) • Attachments:each segment is attached to a pair of spinal nerves • Enlargements: • Cervical (C3 to T1): gives the brachial plexus supplying the upper limb • Lumbar (L1 to S3): gives lumbar & sacral plexus supplying the lower limb

  14. THE SPINAL CORD • Cauda equina (horse’s tail):collection of lumbar, sacral & coccygeal nerves below the termination of the spinal cord • Filum terminale:a thin fibrous band extending from the tip of conus medullaris ( in the middle of cauda equina) to the dorsal surface of first coccygeal vertebra

  15. Spinal nerves

  16. Spinal nerves • Number:31 pairs (8 cervical , 12 thoracic, 5 lumbar, 5 sacral & 1 coccygeal) • Types of fibers:mixed (sensory + motor) • Site of exit from vertebral canal: • C1 to C7:leave above corresponding vertebrae. • C8: leaves below C7 vertebra. • T1 to L5: leave below corresponding vertebrae. • S1 to S4: Leave throughsacral foramina. • S5 & coccygeal nerve: leave throughsacral hiatus.

  17. FORMATION OF A SPINAL NERVE

  18. Constituents of a typical spinal nerve It is attached to spinal cord by 2 roots: • Dorsal (posterior) sensory root: formed of afferent neurones;their cell bodies are located in the dorsal root ganglia which appear as enlargements in the root near the intervertebral foramen. • Ventral (anterior) motor root: formed of efferent neurones;their cell bodies are located in the grey matter of spinal cord. Both roots unite to form the spinal nerve, just before its exit from intervertebral foramen.

  19. Constituents of a typical spinal nerve After its exit: the spinal nerve divides into: • Dorsal (posterior) ramus: a small mixedbranch that supplies skin & muscles of the back. • Ventral (anterior) ramus: a larger mixedbranch that supplies skin & muscles of limbs and antero-lateral body walls.

  20. SPINAL NERVE INJURY • Spinal nerves are exposed to compression by : • Spondylosis: degenerative changes in the joints of vertebral column • Prolapse of intervertebral discs • Prolapse is common is lumbar region leading to back pain radiating into the legs (sciatica)

  21. Spinal meninges

  22. Spinal meninges Dura matter: • Outer covering, thick & dense membrane • Separated from the periosteum of the vertebral column by a space called the epidural space containing loose fat & a plexus of veins (epidural or internal vertebral venous plexus) • Ends at the level of S2

  23. Spinal meninges Arachnoid matter: • Translucent membrane, between the dura & pia matters • Separted from dura by a space called subdural space containing serous fluid acting as a bursa between the tough dura & the delicate arachnoid. • Separated from pia by a space called subarachnoid space containing cerebrospinal fluid & blood vessels. • Ends at level of S2

  24. Spinal meninges • Both dura & arachnoid extend to form sleeves for ventral & dorsal roots extending as far as fusion of both roots to form the spinal nerves • They become continuous with the epineurium of the spinal nerve

  25. LUMBAR PUNCTURE • The subarachnoid space is large below the level of termination of spinal cord (from L2 to S2). This site is a favorable site for lumbar puncture (best between L3 & L4 or L2 & L3)

  26. Spinal meninges Pia matter: • Inner delicate, vascular, closely applied to spinal cord. • Along a line midway between the dorsal & ventral roots, the pia projects laterally to form denticulate ligaments that pass through arachnoid to be attached to dura.

  27. Blood supply of spinal cord

  28. Blood supply of spinal cord Arterial supply: • Longitudinal arteries:one anterior spinal & two posterior spinal arteries • Branches of 4th part of vertebral artery • Posterior spinal arteries may arise from posterior inferior cerebellar arteries • Run along the length of spinal cord (the anterior artery runs along the anterior median fissure, the posterior arteries run behind the dorsal roots) • Main supply for cervical part of spinal cord

  29. Blood supply of spinal cord Arterial supply: 2)Transverse (Radicular) arteries: • Branches of segmental artery (vertebral, ascending cervical, posterior intercostal, lumbar arteries) • Enters through intervertebral foramen and divides into anterior & posterior branches running along the ventral & dorsal roots of the spinal nerve. • The great radicular artery (artery of Adamkiewicz): a particular large artery that may arise from intercostal or lumbar arteries (from T8 to L3) • Main supply of the spinal cord, below cervical levels

  30. Blood supply of spinal cord Venous drainage: • Six longitudinal veins:one anterior, one posterior, two anterolateral & two posterolateral veins. • The veins drain into the anterior & posterior radicular veins which end into the internal vertebral venous plexus.

  31. Disorders of blood supply • The anterior portion of spinal cord together with its arterial supply (anterior spinal artery) are more liable to be damaged in the thoracic region • Occlusion of anterior spinal artery leads to an acute thoracic cord syndrome with paraplegia & incontinence

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